Irregular Menstrual Cycles

Is your period normal? In this short video, Dr. Gargey Patil answers this common question.

When should you see a physician for irregular bleeding? Dr. Mark Crider discusses this topic in this video.  

Causes of irregular menstrual cycles

Anovulation

The most common cause of irregular uterine bleeding is anovulation. This is when an egg does not release from the ovary every month.  If an egg is not released, the uterine lining can become too thick due to low levels of progesterone.  When bleeding finally occurs, it can be very heavy.  Anovulatory bleeding is most common at the beginning (adolescence) and end (menopause) of a woman’s menstrual lifetime.

Polycystic Ovarian Syndrome (PCOS)

PCOS is a specific type of ovulation problem caused by an imbalance of various hormones and insulin.  Women with PCOS may have several other medical problems,  including irregular menstrual cycles, difficulty conceiving, increased hair growth on the face, chest, or other areas (called hirsutism), and in some cases, diabetes or cholesterol problems. 

Weight loss, intense exercise, stress

Women who exercise intensely, have significant weight loss or stress can develop irregular menstrual cycles..If this continues for a long time, abnormalities of bone development can occur. 

Thyroid or brain abnormalities

The thyroid gland is in the neck and helps control metabolism. Women may experience irregular cycles if they have low thyroid, called hypothyroidism can, or an overproduction of a hormone called prolactin, the hormone responsible for producing breast milk. These women often complain of a white, thin, nipple discharge. 

Sexually transmitted infections

Certain sexually transmitted infections, such as Chlamydia and gonorrhea, may cause irritation of the uterine lining which can cause spotting or irregular bleeding.

Diagnosing irregular cycles

Most tests used to diagnose irregular cycles measure hormone levels.  After performing a careful history and perhaps a gentle exam, your physician will most likely order a thyroid blood test to measure prolactin level, a test to check for PCOS, and perhaps a sonogram.  If you have increased hair growth on your face, chest, or other areas where males have hair, your physician will order a test to check testosterone level.  If you have had irregular cycles for many years, you may be at risk for uterine cancer or pre-cancer and your physician may recommend a brief uterine biopsy (see information below).  Regardless of the test, it is usually a straightforward process to find the cause of irregular cycles and develop a treatment plan.

Treatment options for irregular cycles

Hormonal Medications

Since most irregular cycles are caused by hormonal problems, hormonal medications are usually prescribed.  Treatment options are very individualized, and depend on whether you would like to start a family soon and how bothersome the symptoms are.  Examples of common hormonal medications include low-dose birth control pills progesterone pills, or, in the case of some women with menopausal irregular bleeding, hormone therapy.

Levonorgestrel (Mirena) IUD

Recent medical evidence has shown that an intrauterine device (IUD)—a form of birth control--  is very effective for treating irregular or heavy bleeding.  An IUD is  a small, T-shaped device your physician inserts into the cervix during a brief office procedure.  The IUD stays inside the uterus and releases a small amount of progesterone which decreases the thickness of the uterine lining, leading to less bleeding. This allows your body to increase your blood count, which treats anemia.  An IUD is not suitable for women who want to start a family soon.

Fertility medications

Women with irregular cycles who are trying to conceive may benefit from low-dose fertility medications.  If your situation requires additional treatment, our physicians will refer you to a fertility specialist for assistance.